It is “Severs Season” across Melbourne! As kids are getting involved in winter sport and as training loads increase, we are starting to see some common injuries hindering participation across many different sports. One particular concern for pre-teen athletes is the onset of heel pain, particularly in high impact running sports such as Hockey, Soccer, Basketball, Netball and Australian Rules.

By far the most common cause of heel pain in the early teens is Severs disease or “calcaneal apophysitis”.  It is most common in children between the ages of 8-14 and it is generally sporting kids that can suffer from the condition.

As kids go through periods of significant growth, it is not uncommon for the growth plate at the back of the heel to be grabbed, pulled and irritated through the Achilles tendon and related posterior leg muscles. This pain can be so severe that walking can become a challenge and no activity can be completed at all. Pain will normally be felt on the side of heel and in the Achilles tendon.

This condition tends not to affect populations past 14 years old, as the growth plate becomes fully ossified within the calcaneus (heel bone) by that time. Factors that predispose a child to developing Severs include a flat or high-arched foot, tight posterior muscles particularly if they are actively engaging in high impact sports.

What should I do if my child has heel pain?

Heel pain is common in children, and most causes of pain are benign and self-limiting however all pain in children should be assessed. So if your child has heel pain you should:

  • Address the pain initially through the use of Ice and Rest
  • Anti-Inflammatory medication used as directed may be of benefit (if tolerated by your child)
  • See a Podiatrist for assessment and treatment options which may include
    • Ensuring appropriate footwear with rearfoot support
    • Stretches or strengthening program
    • In some cases orthotic devices may be recommended.

Severs is something that does resolve with time, and generally does not require any type of surgical intervention. There are simple strategies that can help manage Severs disease, which usually have great results with pain reduction and increased mobility. Kids who show dedication to the treatment program improve rapidly and can be back participating in activity pain free after slight delay and with minimal repercussions.

If you think your child may be suffering from Severs, or other complex foot pain, come and see the Podiatry team at CSSM to help them perform at their best.

About the author – Jim Unkles is a podiatrist at Camberwell Sports and Spinal Medicine.  He understands the demands of competitive sport in children through personal experience in representative Hockey and Cricket. He is currently managing several sporting kids experiencing Severs.

 

References

Marchick, M., Young, H. and Ryan, M.F. (2015) Sever’s Disease: An Underdiagnosed Foot Injury in the Pediatric Emergency Department. Open Journal of Emergency Medicine, 3, 38-40. http://dx.doi.org/10.4236/ojem.2015.34007